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Outbreak
Multiple states have reported large outbreaks of hepatitis A associated with person-to-person transmission. Cases have occurred primarily among three risk groups: (1) persons who use injection or non-injection drugs; (2) persons who are experiencing homelessness; and (3) men who have sex with men. North Carolina is experiencing an outbreak of hepatitis A as described below, though not of the same magnitude as some other states.
Hepatitis A can be prevented by a safe and effective vaccine. If you are in one of the risk groups described (a person experiencing homelessness, a person who uses injection or non-injection drugs, or a man who has sex with men) or if you had contact with someone with hepatitis A, contact your health care provider or local health department about hepatitis A vaccine.
Additionally, always wash your hands with soap and water after going to the bathroom, after changing diapers, and before preparing meals for yourself and others.
| Cases | Hospitalizations | Deaths |
|---|---|---|
| 855 | 535 (62.6%) | 13 (1.5%) |
| County | Cases | Rate per 100,000 Population |
|---|---|---|
| Alamance | 4 | 2.4 |
| Alexander | 7 | 18.7 |
| Ashe | 5 | 18.4 |
| Bladen | 1 | 3.1 |
| Brunswick | 7 | 4.9 |
| Buncombe | 41 | 15.7 |
| Burke | 59 | 65.2 |
| Cabarrus | 17 | 7.9 |
| Caldwell | 38 | 46.2 |
| Carteret | 1 | 1.4 |
| Catawba | 67 | 42.0 |
| Chatham | 3 | 4.0 |
| Cherokee | 13 | 45.4 |
| Clay | 1 | 8.9 |
| Cleveland | 24 | 24.5 |
| Columbus | 2 | 3.6 |
| Craven | 2 | 2.0 |
| Cumberland | 1 | 0.3 |
| Davidson | 61 | 36.4 |
| Davie | 1 | 2.3 |
| Durham | 8 | 2.5 |
| Forsyth | 60 | 15.4 |
| Franklin | 1 | 1.4 |
| Gaston | 78 | 34.7 |
| Gates | 1 | 8.6 |
| Graham | 2 | 23.7 |
| Guilford | 16 | 3.0 |
| Harnett | 4 | 2.9 |
| Haywood | 5 | 8.0 |
| Henderson | 16 | 13.6 |
| Iredell | 7 | 3.9 |
| Johnston | 3 | 1.4 |
| Lee | 3 | 4.9 |
| Lincoln | 21 | 24.2 |
| Macon | 2 | 5.6 |
| Madison | 2 | 9.2 |
| McDowell | 2 | 4.4 |
| Mecklenburg | 48 | 4.3 |
| Montgomery | 5 | 18.4 |
| Moore | 4 | 4.0 |
| New Hanover | 3 | 1.3 |
| Onslow | 2 | 1.0 |
| Orange | 4 | 2.7 |
| Polk | 4 | 19.3 |
| Randolph | 60 | 41.8 |
| Richmond | 9 | 20.1 |
| Rockingham | 3 | 3.3 |
| Rowan | 34 | 23.9 |
| Rutherford | 3 | 4.5 |
| Stokes | 17 | 37.3 |
| Surry | 22 | 30.6 |
| Swain | 1 | 7.0 |
| Transylvania | 7 | 20.4 |
| Union | 2 | 0.8 |
| Wake | 16 | 1.4 |
| Watauga | 2 | 3.6 |
| Wayne | 6 | 4.9 |
| Wilkes | 16 | 23.4 |
| Yadkin | 1 | 2.7 |
| TOTAL | 855 | 8.2 |
Figure 1: Confirmed outbreak-associated cases of hepatitis A in North Carolina, county map: January 01, 2018 – May 12, 2021 (n=777)
Figure 2:Confirmed outbreak-associated rates of hepatitis A in North Carolina, county map: January 01, 2018 – May 12, 2021 (n=777)
An acute illness with a discrete onset of any sign or symptom consistent with acute viral hepatitis (e.g., fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, and abdominal pain), and either a) jaundice, or b) elevated serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels.
Confirmed:
*And not otherwise ruled out by IgM anti-HAV or NAAT for hepatitis A virus testing performed in a public health laboratory
Outbreak-associated case:
An acute case of hepatitis A meeting the confirmed case classification with onset on or after January 1, 2018 in a North Carolina resident who:
